Evaluation Of Right Ventricular Function In Patients With Coronary Heart Disease And Diabetes Mellitus By Tissue Doppler Imaging And Tei Index

Objective:The aim of the study was evaluation of right ventricular function in patients of coronary heart disease (CHD) with diabetes mellitus (DM) by tissue Doppler imaging (TDI) and Tei index to revealing the change of the heart because suffering from both CHD and DM.Methods:1. Echocardiography were performed in 51 patients with CHD(CHD group),30 patients with DM(DM group),46 patients with CHD and DM(CHD and DM group) and 40 normal subjects(control group, NC).2. Applying with GE Vivid7 Dimension Ultrasound Diagnostic Applications, left atrial diameter (LA), left ventricular end diastolic diameter (LVED), right ventricular end diastolic diameter (RVED), left ventricular ejection fraction (LVEF), right atrial diameter (RA) and mitral valve E/A ratio (MV E/A) were measured by conventional two-dimensional echocardiography. Peak systolic and early and late diastolic velocities of the tricuspid annulus and right ventricular (RV) myocardium were recorded at the RV free wall and RV side of interventricular septum by TDI. And isovolumic contraction time (IVCT), ejection time (ET), isovolumic relaxation time (IVRT) and diastolic filling time (DFT) were also measured by TDI. Therefore, we can calculate right ventricular systolic myocardial performance index (RVSMPI) [RVSMPI=IVCT/ET], right ventricular diastolic myocardial performance index (RVDMPI) [RVDMPI)=IVRT/DFT] and Tei index [Tei index=(IVCT+IVRT)/ET]. Above indicators were measured three cardiac cycles and were averaged at last.Results:1. BMI of three experimental groups were higher than NC (respectively, 26.01±2.48,26.22±1.55,26.32±1.98 and 23.81±2.21,p<0.01). The difference of BMI among three experimental groups were no statistical significance(p>0.05).2. TG of DM group and CHD and DM group were higher than CHD group and NC (respectively,2.94±1.42,2.84±1.23及1.61±1.03,1.32±0.70mmol/L,p<0.05). LDL-c of CHD group and CHD and DM group were higher than DM group and NC (respectively,3.51±1.56,3.86±1.34 and 2.93±0.97,2.67±0.68 mmol/L,p<0.05). 3. LA of three experimental groups were larger than NC (p<0.05). MV E/A of them were lower than NC (p<0.001). The differences of LVED, RVED, LVEF and RA among four groups were no statistical significance(p>0.05).4. Em,Em/Am of three experimental groups were lower than NC(p<0.05). Am of DM group were higher than CHD group and NC(p<0.001). The differences of Sm among four groups were no statistical significance(p>0.05).5. RVE of three experimental groups were lower than NC(p<0.05).RVA of middle section and fundus section of RV free wall of CHD group were lower than DM group and NC(p<0.05). The differences of RVS among four groups were no statistical significance(p>0.05).6. When compared with NC, IVRT of three experimental groups were increased and ET and DFT of them were reduced (p<0.01). RVSMPI of three experimental groups were higher than NC (p<0.05). RVDMPI of them were higher than NC (p<0.01).7. Tei index of tricuspid annulus of three experimental groups were higher than NC (p<0.01).8. The course of DM was negatively correlated with Em/Am of tri cuspid annulus (r=-0.636,p<0.01).Conclusion:1. The patients with CHD and DM possessed higher BMI and blood lipid level. LDL-c was mainly increased in CHD. TG was mainly increased in DM.2. While left ventricular systolic function (EF) of CHD group, DM group and CHD and DM group was no statistical significance, the left and right ventricular diastolic function of them were impaired. But the right ventricular systolic function index (Sm) of them was no significant change. It suggests that the two diseases mainly or firstly affect ventricular diastolic function.3. The course of DM may be one of the factors to affect the right ventricular diastolic function.4. Compared with DM group and CHD group, the right ventricular function of CHD and DM group was not further impaired. We still need to increase the sample size to confirm it by further studies. 5. Given the current lack of "the gold standard" of right ventricular function, that we combine with many ultrasonic parameters to comprehensively evaluate it is regarded as a clinical method.